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目的通过对子宫内膜异位症(endometriosis,EMs)生育指数(endometriosis fertility index,EFI)的研究,探讨其对EMs合并不孕患者生育力评估的临床价值。方法前瞻性分析中山市博爱医院生殖内分泌科2014年1月至2015年11月因不孕就诊,行腹腔镜检查证实为EMs患者190例,术中进行EFI评分;术后随访12个月,随访术后疗效及妊娠情况。结果术后12个月累积妊娠率48.42%(92/190)。期待自然妊娠患者的累积妊娠率,在EFI评分8~10分组为46.51%(20/43),高于5~7分组(15.38%,2/13),差异有统计学意义(χ~2=5.2,P<0.05)。促排卵-人工授精(controlled ovarian hyperstimulation-intrauterine insemination,COH-IUI)患者的累积妊娠率,EFI评分8~10分组为59.45%(22/37),高于5~7分组(33.33%,8/24),差异有统计学意义(χ~2=3.98,P<0.05)。体外受精-胚胎移植(in vitro fertilizationembryo transfer,IVF-ET)患者的累积妊娠率,在EFI评分8~10分组为69.69%(23/33),高于5~7分组(50%,15/30)及1~4分组(20%,2/10),差异有统计学意义(χ~2=8.12,P<0.05)。EFI与术后1年累积妊娠率有关(P<0.05)。在EFI评分8~10分组及5~7分组,IVF-ET患者的累积妊娠率均较期待自然妊娠患者增高,差异有统计学意义(χ~2=4.09、4.55,P<0.05);COH-IUI患者的累积妊娠率与自然妊娠患者比较差异均无统计学意义(χ~2=1.34、1.38,P>0.05)。结论 EMs患者EFI与术后妊娠率呈正相关,能够评价EMs合并不孕患者的生育能力;腹腔镜术后辅助IVF-ET术可以提高患者的妊娠率。因此EFI评分对指导有生育要求的EMs患者进行生育方式的选择有一定的意义。
Objective To investigate the clinical value of assessing fertility in EMs with infertility by studying the endometriosis fertility index (EFI) of endometriosis (EMs). Methods Prospective analysis of reproductive endocrinology department of Pok Oi Hospital of Zhongshan City from January 2014 to November 2015 due to infertility treatment, laparoscopy confirmed 190 cases of EMs patients, EFI score during surgery; 12 months after follow-up, follow-up Postoperative efficacy and pregnancy status. Results The cumulative pregnancy rate at 12 months after operation was 48.42% (92/190). The expected pregnancy rate of pregnant women with natural pregnancy was 46.51% (20/43) in the 8-10 EFI group and 15.38% (2/13) in the 5-7 group (χ ~ 2 = 5.2, P <0.05). The cumulative pregnancy rates in patients with COH-IUI were 59.45% (22/37) in the EF group with EFI score of 8-10 and higher than those in the 5-7 group (33.33%, 8 / 24), the difference was statistically significant (χ ~ 2 = 3.98, P <0.05). The cumulative pregnancy rates in in vitro fertilization-embryo transfer (IVF-ET) patients were 69.69% (23/33) in the EFI score of 8-10 and were higher in the 5-7 group (50%, 15/30 ) And 1 ~ 4 group (20%, 2/10), the difference was statistically significant (χ ~ 2 = 8.12, P <0.05). The EFI was associated with 1-year cumulative pregnancy rate (P <0.05). The accumulative pregnancy rates of patients with IVF-ET were significantly higher than those of expectant normal pregnancies in EFI scores of 8 to 10 and 5 to 7 (χ ~ 2 = 4.09, 4.55, P <0.05) The cumulative pregnancy rates in IUI patients were not significantly different from those in natural pregnancy (χ ~ 2 = 1.34,1.38, P> 0.05). Conclusion The EFI of EMs is positively correlated with postoperative pregnancy rate, which can evaluate the fertility of patients with EMs complicated with infertility. Assisted IVF-ET after laparoscopic surgery can improve the pregnancy rate of patients. Therefore, EFI score to guide the fertility requirements of EMs patients have a certain choice of fertility mode.